Psychotherapie der Psychosen

In this paper the psychotherapy of patients with schizophrenic, schizoaffective and affective psychoses is outlined. Psychoanalytic, cognitive-behavioural and systemic approaches and their theoretical concepts as well as the therapeutic techniques are de- scribed. The settings of individual, group and family therapy are also presented. A survey of the types of psychoanalytic therapy with their eldest historic roots is given with the development of the various psychodynamic concepts for schizophrenic and affective psychoses including schizoaffective psycho-ses. The different kinds of psychotherapy are compared to each other with respect to the aims. Finally this paper deals with the effectiveness of the therapies and discusses the pros and cons of relatively short randomised controlled trials compared with long term psychotherapies without control groups.     

Kombination von Settings und Verfahren in der Psychotherapie

Literature research and own clinical experiences confirm the significance of a combined use of settings and methods in the area of inpatient and outpatient psychotherapy. For inpatient treatment, the combined use of methods, such as individual psychotherapy, group therapy, creative therapies, and sport, are an essential part of the treatment. In outpatient treatment, the regulations of the German insurance do not permit such combinations. Nevertheless, they occur and are often proactively initiated by the patients. The various combined use of psychotherapy and psychotropics is very well studied, but also the combination of settings, i.e. supplementary inpatient treatment, day treatment, and outpatient treatment have to be considered. While administering their therapies, psychotherapists should keep in mind possibly concurrently ongoing treatments as well as former therapies and their effects on the patients. With the exception of combinations with psychotropic treatment, there exist almost no empirical data in this important field.     

Psychotherapie von Kriegs- und Folteropfern

Within the context of worldwide migratory movements, numerous victims of war and torture are moving into western countries. Frequently, these patients are in need of psychotherapy, which is partly provided by specialized institutions. Psychotherapists of victims of war and torture have to deal with manifold additional physical, social, material, and legal problems of their clients. Therefore, such patients are best treated by multidisciplinary teams. The psychotherapy of such victims involves the classical methods for the treatment of PTSD; however, these methods may be of limited effect in these patients due to high comorbidity. Additional methods and concepts known from the treatment of complex PTSD and borderline personality disorders must be integrated into therapeutic strategies.     

Gewalt und Missbrauch in der Psychotherapie

Starting from the fundamental ethical principles of medicine, the different forms of abuse in psychotherapy are described and discussed in the context of particular case studies. Besides sexual abuse, also the more subtle violations of basic ethical principles are taken into consideration. These include especially orally-exploitative forms of abuse, therapists’ improper acting-out of their own desires for close attachment or dominance conflicts, and narcissictic abuse. Finally, a particular type of narcissistic abuse is dealt with: the over-emphasis on the therapist’s own therapeutic method, with a tendency to dismiss alternative treatment strategies that might be more appropriate for the individual patient.     

Die Wiederherstellung der Zeit in der ambulanten Psychotherapie mit Psychosekranken

In psychoanalytic psychotherapy with psychotic patients, a disturbance in time experience quite frequently turns out to be central to the psychotic experience as a whole. These patients experience disruptions in the flow of time that lead to a loss of temporal continuity. This loss of temporal structures causes damage in thinking functions: Relations like causality, finality and others which imply a temporal dimension, cannot be established any more. Parts of treatment histories serve to demonstrate the reconstruction of temporal continuity by the patient in psychotherapy. Object-relation-theory and Piaget’s experimental psychology provide the frame of reference for the understandig of the mental processes involved. At the beginning of the psychotherapy the patient experiences being together with the therapist and being separated from him as two discrete conditions of existing which have no links. The periodical reappearance of being together in combination with the awareness of the therapist’s continuous ongoing care encourages the patient to remember and to envisage the meetings with the therapist. The reliability of the alternation seems to stimulate a specific mental activity which creates connections allowing for transitions between the different conditions — in the sense of Winnicott’s transitional phenomena. Transitional phenomena which sometimes are quite concrete things bridge the gap between presence and future. Narrating serves as a link to the past. Through these creative ego-activities temporal continuity is regained providing the basis for strucured thinking and — very important — for the perception of one’s own personality and its continuity over time, thus generating a sense of identity. This process of reconstructing time is interesting in itself, because it sheds light on the psychodynamics of the restitutional processes after a psychotic illness. Moreover, it allows for hypotheses about the development of the inner time dimension in early childhood.     

Der Einsatz von Hausaufgaben in der Psychotherapie

Homework is not only an essential part of cognitive-behavioral treatment but is also used in a variety of other therapy approaches. Its positive relation to therapy outcome has been proved. In consequence, patients’ compliance with homework assignments is an important therapeutic goal. In the last years, numerous papers focused on recommendations for enhancing acceptance and completion of homework assignments. The present article provides an overview about existing recommendations. Proposals are summarized and opposed to empirical studies on single homework procedures and their influence on homework compliance. Due to a lack of empirical data, the effectiveness of most recommendations could not yet be proved. General problems in homework study design and possible directions of further research addressing homework use are discussed.     

Telemedizin als effizientes Werkzeug in der Konsultation von Menschen mit Alkoholabhängigkeit

psychopraxis. neuropraxis - Zur Sicherstellung der Kontinuität der Versorgung suchtkranker Patienten zwischen dem ambulanten und stationären Sektor wurde ein Pilotprojekt der Telemedizin...     

Aktuelle Probleme der Krankenhausplanung in der Psychosomatischen Medizin und Psychotherapie

Ohne Zusammenfassung

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Standards der sozialmedizinischen Leistungsbegutachtung in der Psychosomatischen Medizin und Psychotherapie

Sociomedical problems are playing an increasingly important role in both psychosomatic medicine and psychotherapy and in psychiatry. The present article examines the standards relating to content and method in sociomedical assessments, primarily in the discipline of psychosomatic medicine and psychotherapy. The focus is on the assessment of performance, highlighting the fact that performance and performance deficits cannot primarily be derived from the medical diagnosis; instead, psychosocial variables that influence the processes of dealing with disease in particular affect the actual performance status. The article pays particular attention to aspects that aggravate or dissimulate performance competence. Finally, the principles of integrating the various findings and results that are incorporated into the assessment report are outlined.     

Die Krankheitslehre der Psychoanalyse. Allgemeine und spezielle psychoanalytische Theorie der Neurosen, Psychosen und psychosomatischen Erkrankungen bei Erwachsenen, Kindern und Jugendlichen, 6. Aufl. Herausgegeben von Helmut Hinz

Ohne Zusammenfassung